CASE STUDY

Unintended Consequences of the Hospital Readmissions Reduction Program

The Client’s Challenge

Our Solution

Readmission rates have declined since announcement of the Hospital Readmissions Reduction Program (HRRP; part of the Affordable Care Act), but questions remain about whether hospital readmission rates reflect hospital quality (NEJM JW Hosp Med Jan 2018 and N Engl J Med 2017; 377:1055) and whether efforts to prevent readmissions compromise patient safety.

In this retrospective analysis of >8 million Medicare hospitalizations (2005–2015) for heart failure, myocardial infarction (MI), or pneumonia, researchers found some significant associations between HRRP and excess mortality within 30 days of discharge. For patients hospitalized with heart failure or pneumonia, 30-day postdischarge mortality rose by 0.22% after HRRP announcement and by as much as 0.40% after HRRP implementation. Mortality after MI was unaffected. When investigators employed a different outcome measure (45-day mortality from first admission day), HRRP implementation was not associated with excess mortality for any of these conditions.

COMMENT
The increase in 30-day postdischarge mortality was driven mainly by patients who were not “officially readmitted” to the hospital, suggesting that HRRP might have led to patients being managed for acute issues in emergency departments or observation units instead of inpatient units following their index admissions. Given these potentially worrisome findings, better understanding is needed before continuing a policy that might be harming patients inadvertently.

Our IMPACT